In patients with a LIMA graft, unusual relief of angina during left arm exertion may indicate altered hemodynamics, prompting suspicion for great vessel disease such as subclavian artery stenosis.
May prompt subclavian stenosis evaluation in LIMA patients with left-arm angina relief; leaves open reproducibility of conduit flow effects.
In patients with known coronary artery disease and/or a history of revascularization, angina pectoris or unstable coronary syndromes are usually attributed to the progression of atherosclerotic lesions rather than an unrecognized great vessel disease. However, for patients with a previous coronary artery bypass graft operation (CABG), during which a left internal mammary artery (LIMA) conduit has been used, great vessel disease, especially subclavian artery stenosis should also be suspected. We present a case of a patient with a LIMA conduit who has angina pectoris on exertion, but interestingly the pain is relieved when he carries heavy loads with his left hand, which can be due to increased blood flow to the LIMA conduit during heavy lifting because of increased peripheral resistance.
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Tanındı et al. (2010) studied this question.
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